Muharrem Uçar

Association between cigarette smoking and depressive symptoms among military medical students in Turkey

An association has been documented between two important health concerns, smoking and depression. A cross-sectional study was carried out to explore whether this relationship exists in a sample of Turkish military medical undergraduates. Of a total of 779 military medical undergraduates, 690 agreed to participate in the study. The students completed a self-administered questionnaire including the Turkish adaptation of the Beck Depression Inventory (BDI) and gave a smoking history. It was determined that the smokers among medical students were 2.2 times more likely to have depressive symptoms than nonsmokers. This result extends the significant association between smoking and depressive symptoms in the literature to a sample of Turkish military medical undergraduates.

Relation between Machiavellianism and Job Satisfaction in a Sample of Turkish Physicians

Job satisfaction is affected by many factors. A consistent negative correlation between Machiavellianism and Job satisfaction was shown by many previous studies. To estimate this association in a sample of Turkish people, 361 physicians were selected among the total number of 5,959 working in Ankara City Center. A self-administered questionnaire including the Mach IV scale and Job Satisfaction scale developed by Kasapoğlu was applied to the subjects. Student t test and Pearson correlation were used for analysis. The correlation of –.25 between Job Satisfaction and Machiavellianism scores was significant and consistent with the mean scores on Job Satisfaction between the Machiavellian and Nonmachiavellian groups. Although the present association is small, the inverse value is consistent for Mach IV scale scores with job satisfaction in the literature.

Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis: Prospective, Randomized, Double-blinded Study

Study Design. A prospective, randomized, double-blinded study. Objective. The aim of this study was to compare the efficacy and side effects of patient-controlled intermittent bolus epidural analgesia (PCIEA) and patient-controlled continuous epidural analgesia (PCCEA) for postoperative pain control in adolescent idiopathic scoliosis. Summary of Background Data. Epidural analgesia is an accepted efficacious and safe procedure for postoperative pain management in scoliosis surgery. However, the PCIEA has not been adequately investigated for postoperative pain control in adolescent idiopathic scoliosis. Methods. Forty-seven patients, 8 to 18 years of age, who were undergoing posterior spinal fusion for idiopathic scoliosis were randomized to either the PCIEA or PCCEA group. An epidural catheter was inserted by a surgeon under direct visualization. The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg of morphine bolus, additional doses of 0.25 mL/kg morphine with a 1-hour lockout given by patient-controlled demand, and no infusion. The PCCEA group received the following: 0.2 mg/mL morphine, an initial morphine loading set at 0.1 mL/kg, followed by a 0.05 mL/kg/h continuous infusion of morphine, and a 0.025 mL/kg bolus dose of morphine. There was a 30-minute lockout interval. The primary outcome was morphine usage. The secondary outcomes were pain score, postoperative nausea and vomiting, and pruritus. Results. Cumulative morphine consumption was lower in the PCIEA group than in the PCCEA group. Both methods provided effective pain control. There were no differences in pain scores between the groups. Postoperative nausea, vomiting, and pruritus were lower in the PCIEA group. Conclusion. The two epidural analgesia techniques studied are both safe and effective methods for postoperative pain control after posterior spinal fusion in idiopathic scoliosis. Nausea, vomiting and pruritus were considerably higher in the PCCEA group. Concerns regarding side effects associated with epidural opioids can be avoided by an intermittent bolus with a relatively lower amount of opioid. Level of Evidence: 2

What do patients expect from their physicians? Qualitative research on the ethical aspects of patient statements

This study aimed to examine the thoughts and expectations of patients receiving healthcare from their physicians and evaluate the ethical aspects of these thoughts and expectations. To determine the ethical aspects of the thoughts and expectations of patients, an open-ended question was asked on the web page of the Turkish Armed Forces (TAF) Health Care Command, which is accessible to the users of the TAF intranet system (the internet system used within TAF institutions). The participants were asked to express their thoughts in their own words. A total of 804 participants answered the question by providing their input. The statements of the participants were classified separately by two public health specialists. The classification was made in accordance with the basic principles of patient rights, and they were collected under various headings including expectations about respect and care, good communication, informed consent, and fair and non-privileged distribution of healthcare services. The results show that patients tend to consider the physicians they see as solely responsible for all the negative issues that they encounter during their healthcare. This indicates that there is a need for extensive research on the underlying factors involved in the negative thoughts and feelings toward healthcare professionals in both TAF and Turkey in general.

Military Medical Graduates' Perceptions of Organizational Culture in Turkish Military Medical School

Organizational culture is the term used to describe the shared beliefs, perceptions, and expectations of individuals in organizations. In the healthcare environment, organizational culture has been associated with several elements of organizational experience that contribute to quality, such as nursing care, job satisfaction, and patient safety. A range of tools have been designed to measure organizational culture and applied in industrial, educational, and health care settings. This study has been conducted to investigate the perceptions of military medical graduates on organizational culture at Gülhane Military Medical School. A measurement of organizational culture, which was developed by the researchers from Akdeniz University, was applied to all military medical graduates in 2004. This was a Likert type scale that included 31 items. Designers of the measurement grouped all these items into five main dimensions in their previous study. The items were scored on a five-point scale anchored by 1: strongly agree and 5: strongly disagree. Study participants included all military physicians who were in clerkship training period at Gulhane Military Medical Academy in 2004. A total of 106 graduates were accepted to response the questionnaire. The mean age of participants was 25.2 ± 1.1. At the time of study only 8 (7.5%) graduates were married. The study results have showed that the measurement tool with 31 items had a sufficient reliability with a Cronbachs alpha value of 0.91. Factor analysis has resulted a final measurement tool of 24 items with five factors. Total score and the scores of five subdimensions have been estimated and compared between groups based on living city and marital status. The study has shown the dimension of symbol received positive perceptions while the dimension of organizational structure and efficiency received the most negative perceptions. GMMS has a unique organizational culture with its weak and strong aspects. Conducting this kind of studies contribute to improve organizational culture in order to increase educational and research capability.

Our clinical experiences in ultra-sound guided peripheral nerve blocks: a retrospective evaluation

Peripheral nerve blocks are commonly used in extremity surgeries for anesthetic and/or postoperative analgesic purposes with general anesthesia. Ultra-sound (US) guided peripheral nerve blocks that have been used in recent years provide many superiorities in comparison with other conventional methods. The objective of this retrospective study was to carry out a retrospective evaluation of our experiences regarding 400 patients on whom US guided peripheral nerve was applied at the Inonu University Faculty of Medicine, Department of Anesthesiology and Reanimation during June 2012-March 2016. Demographic data of the patients, block type, purpose of block (for surgical or analgesic), type and volume of the local anesthetic, type of US probe, needle length, block success, toxicity finding and complications were all recorded. Blocks were performed for analgesia in 16% of the patients and for anesthesia in 84%. Lidocaine+bupivacaine combination, bupivacaine+prilocaine combination and bupivacaine were used on 82%, 13% and 5% of the patients as local anesthetic agent, respectively. Linear US probe (6-13 MHz) was used for all patients. In conclusion, US guided peripheral nerve blocks provide adequate depth of anesthesia and analgesia. It was found to be safe and useful and may be a good alternative to general anesthesia.

Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma.

Phaeochromocytoma is a catecholamine-secreting vascular tumour that is derived from chromaffin cell. Lethal cardiovascular complications, such as serious hypertension, myocardial infarction and aortic dissection, may occur because of uncontrolled catecholamine release. Each stage of anaesthesia management has vital importance because of this destructive catecholamine secretion that may occur during induction, perioperative stage and surgical manipulation. In this study, we report regarding the preoperative preparation and severe, persistent hypertension attack management with a combination of α-adrenergic blockade, β-adrenergic blockade, sodium nitroprusside and remifentanil in a patient who underwent laparoscopic surgery for phaeochromocytoma.

Regional Anaesthesia Management in a Patient with Leprosy: Rare Case with Rare Application

Leprosy is a chronic infectious disease that is caused by Mycobacterium leprae and affects the skin and nerves. Patients with leprosy having related peripheral neuropathy and involvement of other organs may have cardiac, respiratory dysautonomia and autonomic dysfunctions. There are very few studies regarding anaesthetic management of patients suffering from leprosy. Moreover, very few studies concerning regional anaesthesia in patients with lepromatous leprosy have been reported. In this study, we aim to assess regional anaesthesia management with combined spinal epidural anaesthesia in a patient who had been followed up with a diagnosis of leprosy for a long time and was scheduled for operation because of a femoral neck fracture.

The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties.

BACKGROUND/AIM The objective of this study was to examine the effect of addition of subanesthetic doses of ketamine to an epinephrine-lidocaine solution on postoperative pain, analgesic use, and patient comfort during rhinoplasties. MATERIALS AND METHODS Ninety patients were randomly divided into three groups: Group L, lidocaine with epinephrine; Group K, lidocaine with epinephrine plus ketamine; and Group S (control group), physiological saline solution with epinephrine. The local anesthetic solution was injected as preincisionally with intranasal submucosal infiltration following induction of general anesthesia. We evaluated visual pain score, analgesic demand, Wilson sedation score, and antiemetic demand at 5, 15, and 30 min and 1, 2, 4, 6, 8, 16, and 24 h after the operation. The patient satisfaction score was checked 24 h after the operation. RESULTS Visual pain score was significantly reduced in Group K in comparison with the other groups and this group did not need any rescue analgesics (P < 0.05). The postoperative patient satisfaction scores were highest in Group K compared with the other groups (P < 0.05). CONCLUSION Addition of ketamine solution to lidocaine for infiltration block during rhinoplasty was successful in decreasing pain during postoperative periods and reducing analgesic consumption during the first 24 h after the operation.

Reliability of the Turkish version of Mach IV scale: results obtained from two previously published studies.

Values of coefficient alpha from previously published studies for men (.55 and .63) and women (.47 and .51) are lower (.54 and .59) than the recommended value (.70).